Two Years from Now, in 2025, the New Contract with Aetna Will Bring Lower Costs, Transparency, and Generate $140 Million in Administrative Savings
(Raleigh, N.C.) – State Treasurer Dale R. Folwell, CPA, and the State Health Plan (Plan) today announced the award of the Third-Party Administrative (TPA) Services Contract to Aetna. The Plan consists of nearly 740,000 teachers, state employees, retirees and their dependents. The administrative contract, awarded by the State Health Plan Board of Trustees, oversees health care spending of more than $17.5 billion over five years. The new contract reflects a partnership that focuses on transparency and lower costs, with the potential administrative cost savings over the course of the contract equaling $140 million.
The three-year initial service period for the contract begins Jan. 1, 2025, and continues through Dec. 31, 2027, with the option to renew for two, one-year terms.
The award is the result of a Request for Proposals, a competitive bid process in which the Plan solicited and selected industry-leading partners providing exceptional customer service, technological resources and professional support. The services under the contract include processing claims and offering a comprehensive network of health care providers. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is the current TPA for the Plan and has been the TPA for over 40 years.
“We appreciate the years of service that Blue Cross NC has given our members. I’ve spoken with Blue Cross President and CEO Tunde Sotunde, M.D., and Board Chair Ned Curran, and they assure me that they will finish strong for the next two years,” Treasurer Folwell said.
“Partnering with Aetna, which already employs over 10,000 people in North Carolina, will create a lot of new opportunities for the Plan and the members we serve. A change of this magnitude is a great opportunity for a fresh perspective, and we look forward to working closely with Aetna to create new ways to provide price transparency, increase access and quality while lowering the cost of health care for those who teach, protect and serve, and taxpayers like them.”
Aetna was one of three companies bidding for the contract. Blue Cross NC and UMR, Inc. also submitted proposals.
Starting today, nearly 600 Aetna employees have been assigned to work on this transition with State Health Plan Director Sam Watts for the next two years. Aetna will be working diligently, in close collaboration with Plan staff and multiple vendors, to develop comprehensive plans and processes, systems and platforms to ensure members will enjoy a seamless transition when its services roll out.
Plan members will start receiving more information regarding the changes in 2024 prior to Open Enrollment for the 2025 benefit year.
Have you been struggling to keep a positive mindset? Our minds are always working overtime, even if we don’t realize it, and our mindset often has influence over every decision and action that we take, as well as every relationship we maintain – personal or professional. Your mind is so powerful that your mindset can even affect your physical health, in addition to your mental health and emotional wellbeing.
So, what can you do to harness the power of positivity?
Begin every day on a positive note.
Start a daily gratitude journal.
Find something to laugh about every day.
Surround yourself with positive people.
Speak to yourself and others kindly.
Replace negative thoughts with positive ones.
Always choose to see the positive in a situation.
Be aware of what mental images you focus on.
HDHPs may waive the deductible for telehealth services without jeopardizing HSA eligibility for plan years beginning in 2023 and 2024.
The Consolidated Appropriations Act, 2023 (CAA), which was signed into law on Dec. 29, 2022, extends the ability of high deductible health plans (HDHPs) to provide benefits for telehealth or other remote care services before plan deductibles have been met without jeopardizing health savings account (HSA) eligibility. This extension applies for plan years beginning after Dec. 31, 2022, and before Jan. 1, 2025.
To be eligible for HSA contributions, individuals cannot be covered under a health plan that provides benefits, except preventive care benefits, before the minimum HDHP deductible is satisfied for the year. As a general rule, telehealth programs that provide free or reduced-cost medical benefits before the HDHP deductible is satisfied are disqualifying coverage for purposes of HSA eligibility.
However, effective Jan. 1, 2020, the CARES Act allowed HDHPs to provide benefits for telehealth or other remote care services before plan deductibles were met. This relief applied for plan years beginning before Jan. 1, 2022. A spending bill extended this relief to telehealth services provided in months beginning after March 31, 2022, and before Jan. 1, 2023. The CAA further extends this first-dollar coverage for telehealth services to plan years beginning after Dec. 31, 2022, and before Jan. 1, 2025.
The CARES Act allowed pre-deductible coverage of telehealth services for plan years beginning before January 1, 2022.
A spending bill extended this relief to telehealth services provided from April 2022 through the end of 2022.
The CAA extended this relief for plan years beginning after December 31, 2022, and before January 1, 2025.
HDHPs may choose to waive the deductible for any telehealth services for plan years beginning in 2023 and 2024 without causing participants to lose HSA eligibility. This provision is optional; HDHPs can continue to choose to apply any telehealth services toward the deductible. Note that there is a gap for non-calendar-year plans from Jan. 1, 2023 (when the spending bill’s extension expired) to the start of the 2023 plan year, during which this temporary relief for telehealth services does not apply.
Perfect for curious people who love to learn, busy people who don’t have time to read, and even people who aren’t into reading.
Blinkist is an educational app that transforms key insights of over 5,500 bestselling nonfiction books and popular podcasts into powerful explainer clips that you can read or listen to in 15 minutes.
Blinkist can be used for a range of things like quickly catching up on the latest information in your field of interest or previewing books for your next read.
Mental health is a growing concern in the workplace. Over the past few years, many employees have experienced mental health issues, such as burnout, depression, anxiety, and substance abuse. Employers have responded by expanding mental health benefits, including adding mental health programs, increasing schedule flexibility, offering telemedicine options for mental health, and providing more mental health education. Despite the amplified focus on mental health, employees’ mental health issues are still commonly overlooked, especially since they may not be as readily apparent as physical ailments. However, in reality, employees may sometimes be unable to work because of their mental health issues.
While employers pursue various ways to support employees struggling with mental health issues, it’s also important to be aware of and offer appropriate leave under the Family and Medical Leave Act (FMLA). The U.S. Department of Labor (DOL) recently issued a fact sheet relating to an employee’s ability to use FMLA leave for their own or a family member’s mental health condition. This article provides an overview of the FMLA, the DOL’s guidance, FMLA assistance for employees struggling with mental health issues and ways employers can support their employees.
Eligible employees may take FMLA leave to address mental health conditions. Under the FMLA, a mental health condition is considered a serious health condition if it requires inpatient care or continuing treatment by a health care provider.
• Inpatient care — A serious mental health condition that requires inpatient care includes an overnight stay in a hospital or other medical care facility, such as a treatment center for addiction or eating disorders.
• Continuing treatment — A serious mental health condition that requires continuing treatment by a health care provider includes the following:
- Conditions that incapacitate an individual for more than three consecutive days and require ongoing medical treatment, either multiple appointments with a health care provider or a single appointment and follow-up care.
- Chronic conditions that cause occasional periods when an individual is incapacitated and requires treatment by a health care provider at least twice a year.
Some mental health conditions satisfy both of the definitions of “disability” and “serious health condition.” Under the FMLA, a disability is a mental or physical impairment that substantially limits one or more major life activities.
The FMLA uses the Equal Employment Opportunity Commission’s (EEOC) regulations under the Americans with Disabilities Act (ADA) to define and determine if a condition is a disability. According to the EEOC, conditions that “should easily be concluded” to be “substantially limiting” include major depressive disorder, bipolar disorder, post-traumatic stress disorder, obsessive-compulsive disorder and schizophrenia. Periodic conditions are considered disabilities if they substantially limit a major activity when active.
Employers may require employees to submit a certification from a health care provider to support their need for FMLA leave. While the certificate does not require a diagnosis, the information provided must be sufficient to support the need for leave.
The FMLA permits eligible employees to take leave to provide care for a spouse, child or parent who is unable to work or perform other regular daily activities because of a mental health condition. Providing psychological comfort and reassurance that would benefit a family member with a serious health condition who is receiving inpatient or home care is covered under the FMLA.
FMLA leave to provide care for a child with a serious health condition is generally limited to providing care for a child under the age of 18. However, a parent may use FMLA leave to care for a child 18 years and older who is in need of care for a serious health condition if the adult child is incapable of self-care due to a mental or physical disability. The disability does not need to have occurred or been diagnosed before the age of 18; it may start at any age.
By understanding FMLA requirements for mental health conditions, employers can better support their workforce and avoid potential violations. In many situations, employees may be entitled to protections under other federal employment laws, state family and medical leave laws and collective bargaining agreements. Accordingly, employers are encouraged to discuss any specific FMLA-related questions with an employment attorney.
SHELTON EXECUTIVE ASSISTANT
As a valued member of the PGB team, Laura serves as the Executive Assistant to the President of Employee Benefits, David Charland, and the departments he oversees. She also helps with the management of service contracts for PGB and BenAdmin systems, implementation of FSAs, and FSA renewals. During COVID, Laura aided with a number of FSA amendments, pulling together information and collateral to support our clients.
Before joining PGB, Laura worked as a middle school social studies teacher in Wilson County, NC. She holds a bachelor’s degree in history with a minor in criminal justice, a master’s in education as well as a master’s in library and information science. Laura’s favorite part of working for Pierce Group Benefits is the people – who are always there for support and to help with any problems or questions she may run across.
Laura is an invaluable asset to Pierce Group Benefits. She assists and works with nearly every department as well as Leadership, and we are all very grateful for her continued hard work and support in providing our clients and their employees with superior benefits, and personal service!
- PGB Leadership
Whether we’re celebrating early, late, or right on time, Happy Birthday - we hope that this next year is even better than the last!
Brett Hooker - January 1st
Devin Draman - January 1st
Donna Ross - January 7th
Liz Laux - January 7th
Pamala Williams - January 10th
Cori Rozentals - January 13th
Emily Seger - January 26th
Wes Guzman - January 29th
Jeff Lipack - January 30th
Vicki Hale - March 1st
Amanda Keim - March 3rd
Josh Hutchinson - March 6th
Ellie Richards - March 11th
Raquel Bootes - March 16th
Maddie Fansler - March 22nd
Vikki Tollefsen - February 2nd
Annie Snyder - February 6th
Janean Kilgore - February 8th
Jill Pestun - February 12th
Etoria Hill - February 13th
Janna Smith - February 15th
Ty Gainey - March 25th
Nicki Smith - March 26th
Kerri Gilliam - March 27th
Nichole Cayia - March 29th
Anna Stam, - March 31st
Bethany Yarbrough - March 31st
Be it your first year or your twenty-fifth year, THANK YOU for the work you do for Pierce Group Benefits and our clients, and their employees and families!
Karina Branch, Account Executive Admin - Congratulations on 1 year!
Janna Smith, Director of Enrollment Experience - Congratulations on 1 year!
Bethany Yarbrough, Account Executive - Congratulations on 1 year!
Emily Seger, Account Executive - Congratulations on 1 year!
Maddie Fansler, Print Production Assistant - Congratulations on 1 year!
Sharon Borden, Client Relations Specialist - Congratulations on 2 years!
Ty Gainey, Senior Client Relations Specialist - Congratulations on 2 years!
Vicki Hale, Service Specialist - Congratulations on 2 years!
Deja Holley, Director of Marketing - Congratulations on 2 years!
Jeff Lipack, Technical Support Specialist - Congratulations on 2 years!
Katie Payne, Enrollment Technician - Congratulations on 2 years!
Diane Remes, Enrollment Technician - Congratulations on 2 years!
Anna Stam, Account Executive - Congratulations on 2 years!
Lisa Bledsoe, Accounting Assistant - Congratulations on 3 years!
Joshua Hutchinson, Senior EDI Analyst - Congratulations on 3 years!
Lori Kozlowski-McNamara, Senior Benefit Analyst III - Congratulations on 3 years!
Annie Snyder, Account Executive - Congratulations on 3 years!
Sharla Gillespie, Team Administrative Assistant - Congratulations on 4 years!
Liz Laux, Finance Analyst - Congratulations on 4 years!
Michelle Gunter, Account Executive - Congratulations on 4 years!
Michelle Chayka, Executive Assistant - Congratulations on 5 years!
Veronica Lara, Service Center Specialist - Congratulations on 5 years!
Jill Pestun, Senior Benefit Analyst II - Congratulations on 5 years!
Christopher Giannell, Director of Data Management - Congratulations on 6 years!
Becky McKee, Senior Service Specialist - Congratulations on 8 years!
Nicki Smith, Regional Client Services Manager - Congratulations on 10 years!
Quincy Caspar, Print Production Manager - Congratulations on 20 years!
“LUCK IS A DIVIDEND OF SWEAT. THE MORE YOU SWEAT, THE LUCKIER YOU GET”